A dissecting aneurysm of a basilar perforating artery

Aboukaïs, Rabih; Zaïri, Fahed; Estrade, Laurent; Quidet, Mathilde; Leclerc, Xavier; Lejeune, J.-P.

doi:10.1016/j.neuchi.2016.03.003

Cited by 20 publications

(16 citation statements)

References 13 publications

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“…The remaining 31 studies were assessed in full text and, after revision of cross references, 24 retrospective case series met our predefined inclusion criteria and were included in the evidence synthesis. Of the 24 included articles, 19 (79%) had a low risk of bias,2–4 8–23 three (12%) had a medium risk of bias,24–26 and two (8%) had a high risk of bias27 28 (see online supplementary table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Basilar artery perforator aneurysms (BAPAs) are an even rarer and under-reported subtype. Categorizing these aneurysms is a challenging task; Aboukais et al described these aneurysms as those whose neck is entirely located on a perforator artery without direct involvement of the basilar trunk 2. A second classification system aimed at standardizing angiographic descriptions was introduced by Satti et al in 2016 (figure 1).…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Granja

Monteiro

Agnoletto

et al. 2019

J NeuroIntervent Surg

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Background and purposeNon-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs.MethodsMajor databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed.ResultsA total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1–10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0–2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group.ConclusionsIn patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Granja

Monteiro

Agnoletto

et al. 2019

J NeuroIntervent Surg

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“…We performed an analysis of previous reports and our own case based on the type of treatment provided; 23 patients who received conservative management ( Table 1 ) 2 - 4 , 8 - 13) and 18 who underwent endovascular treatment ( Table 2 ) 3 , 8 , 10 , 11 , 13 - 18) were analyzed. Three patients were excluded because they were described in two different articles.…”

Section: Discussionmentioning

confidence: 99%

“…BAPA is an aneurysm with the neck located entirely on a perforating artery without directly involving the basilar trunk. 2) Although the number of cases being reported in recent times is increasing, the natural history is still unknown. We report a specific clinical case in which the source of bleeding was not identified at the onset of SAH; a BAPA appeared during the observation period and then spontaneously disappeared.…”

Section: Introductionmentioning

confidence: 99%

Ruptured Basilar Artery Perforator Aneurysm: A Case Report and Review of the Literature

Enomoto

Shinno

Tamura

et al. 2020

NMC Case Report Journal

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Basilar artery perforator aneurysms (BAPAs) are a rare cause of subarachnoid hemorrhage (SAH), and the natural history is still unknown. Herein, we report a case of ruptured BAPA that appeared during the observation period and then spontaneously disappeared; we have also conducted a review of the literature and performed an analysis based on the type of management. This case of BAPA had a unique course, and our observations may help establish a treatment strategy. A 60-year-old man presented with acute diffuse SAH, World Federation of Neurosurgical Societies (WFNS) Grade II and Fisher Grade 3. Initial three-dimensional digital subtraction angiography (DSA) did not show the source of the hemorrhage. DSA performed on day 39 showed a BAPA with a diameter of 3 mm at the posterior surface of the upper third of the basilar artery. Conservative treatment was chosen. DSA performed on day 64 showed complete resolution of the aneurysm. BAPAs are likely pseudoaneurysms, and not saccular aneurysms, caused due to dissection of basilar perforator arteries . BAPAs are often not recognized on initial imaging, and hence, it is necessary to repeat the DSA examination. Considering the relatively high rate of spontaneous resolution, we chose conservative management. When BAPAs enlarge or do not disappear after conservative treatment, additional therapy such as multiple stents should be considered.

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“…Moreover their definition is controversial. According to Aboukais et al., 1 these are aneurysms whose neck is entirely located on a perforator artery without direct involvement of the basilar trunk. Satti and colleagues 2 describe three types: aneurysms arising from the basilar trunk adjacent to a perforating arterial branch but not involving a perforating artery (Type I); aneurysms originating from the perforating artery base (Type II), with IIa aneurysms incorporating the origin of the perforating arteries and IIb aneurysms having the perforating artery arising from the dome of the aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases

2017

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Basilar trunk perforator artery aneurysms are rare. Their diagnosis and treatment are difficult, controversial, and challenging. Analysis of 52 cases (49 documented in the literature and three personal cases) clearly shows a re-bleeding rate of 15% in patients whose aneurysm has not been occluded and 0% in treated patients ( p < 0.05). The most effective treatment, and the one that presents the least complication, is double-stenting across the basilar trunk.

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A dissecting aneurysm of a basilar perforating artery

Cited by 20 publications

References 13 publications

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?

Ruptured Basilar Artery Perforator Aneurysm: A Case Report and Review of the Literature

Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases

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